A 32yo man presented with painless hematuria. He is hypertensive but the rest of the exam is
unremarkable. What is the most likely dx?
a. Polycystic kidneys
b. Ca bladder
c. Ca prostate
d. TTP
e. HUS
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answer: A
young age + hematuria + HTN =PKD
Signs and Symptoms
• often asymptomatic; discovered incidentally on imaging or by screening those with FHx
• acute abdominal flank pain/dull lumbar back pain
• hematuria (microscopic frequently initial sign, gross)
• nocturia (urinary concentrating defect)
• rarely extra-renal presentation (e.g. ruptured berry aneurysm, diverticulitis)
• HTN (increased renin due to focal compression of intrarenal arteries by cysts) (60-75%)
• ± palpable kidneys
Common Complications
• urinary tract and cyst infections, HTN, CRF, nephrolithiasis (5-15%), flank and chronic back
pain
Clinical Course
• polycystic changes are always bilateral and can present at any age
• clinical manifestations rare before age 20-25
• kidneys are normal at birth but may enlarge to 10x normal size
• variable progression to renal functional impairment (ESRD in up to 50% by age 60)
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